What is Dual Diagnosis

Dual Diagnosis Treatment

Imagine the difficulty of living with not only a substance use disorder, but also struggling with a co-occurring mental health disorder. Experiencing just one disorder or the other is difficult enough, but put them together and daily life can be seriously impacted. But there is help for individuals struggling with co-occurring disorders. Locating a dual diagnosis recovery program that is designed and equipped to treat both disorders simultaneously provides the first step in overcoming this challenge.

What is Dual Diagnosis?

Dual diagnosis is the term used to define the existence of co-occurring, or comorbid, substance use and mental health disorders. According to the 2018 National Survey on Drug Use and Health, about 9.2 million Americans struggle with a dual diagnosis.

In diagnosing and treating individuals with a dual diagnosis, it is sometimes difficult to discern which disorder originated first, the mental health disorder—such as depression, anxiety disorder, or bipolar disorder—or the substance use disorder. In either scenario, one disorder can be a contributing factor for the other disorder developing. For example, someone battling depression might self-medicate by misusing drugs or alcohol, and eventually develop a substance use disorder. On the other hand, a person who abuses alcohol may develop depression as a result of the negative consequences caused by the alcohol abuse. Regardless of the order of onset, a dual diagnosis treatment program will treat both the addiction and the mental health condition simultaneously.

There are certain combinations of co-occurring disorders that are more prevalent. These common dual diagnoses include:

  • Alcohol use disorder and depression
  • Marijuana use disorder and social anxiety disorder
  • Benzodiazepine use disorder and anxiety disorder
  • Alcohol use disorder and PTSD
  • Opioid use disorder and PTSD
  • Cocaine use disorder and anxiety disorders
  • Heroin use disorder and depression

Signs and Symptoms of a Dual Diagnosis

Symptoms of a dual diagnosis are quite diverse based on which disorders are present. There are, however, some general signs and symptoms of a dual diagnosis, including:

  • Impulsive, erratic, high risk behaviors
  • Declining performance at work or school
  • Neglecting personal hygiene
  • Inability to sustain healthy relationships
  • Sudden personality changes
  • Difficulty fulfilling responsibilities and daily obligations
  • Avoidance of social events, isolating behaviors
  • Financial problems
  • Cognitive impairments
  • Obsession with thoughts of suicide and death
  • Mounting legal problems
  • Extreme mood swings

Comprehensive Treatment for Dual Diagnosis

A program that specializes in dual diagnosis treatment will have a psychiatrist on staff. These mental health professionals provide ongoing guidance to the addiction specialists for managing unpredictable psychiatric events that may emerge during treatment, as well as contributing their expertise to designing treatment plans.

Treating a dual diagnosis encompasses both medical and psychosocial interventions. The medical aspect of treatment involves pharmacological assistance to help manage a mental health disorder, such as the prescribing of antidepressants, anti-anxiety medications, mood stabilizers, or anti-psychotic drugs. Medications such as naltrexone or buprenorphine may also be indicated for early addiction recovery support.

The psychosocial interventions assist individuals in making substantive changes in dysfunctional thought patterns that have kept them mired in a cycle of substance abuse. Psychosocial interventions also help the individual:

  • Improve overall functioning
  • Engage in recovery activities
  • Improve interpersonal functioning
  • Establish a structured daily routine
  • Increase the motivation to make fundamental change
  • Reduce the risk of relapse

Integrated treatment elements for dual diagnosis include:

Withdrawal management: Detox and withdrawal should always be medically supervised to ensure safety as well as completion of the detox process. Detox is supported using benzodiazepines and other medical interventions to ease withdrawal symptoms.

Individual psychotherapy: Psychotherapy is an essential core element for treating both co-occurring disorders. The therapist guides the individual through the process of resolving underlying emotional issues, such as a history of trauma, loss, or abuse.

Individual therapy also helps teach new coping skills taught through evidence-based behavior therapies:

  • Cognitive behavioral therapy. CBT helps shift thought distortions that usually lead to addiction behaviors towards healthy new thought patterns.
  • Dialectical behavior therapy. DBT focuses on embracing change through four strategies, including mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
  • Motivational enhancement therapy. MET helps clients resolve feelings of ambivalence about giving up the substance abuse and embracing recovery.

Group counseling. Group therapy supports peer interaction and is a source for both support and accountability for individuals in dual diagnosis treatment. Group therapy sessions involve small groups of individuals with similar dual diagnoses who are encouraged to share about their struggles, frustrations, fears, and other relatable emotions.

Recovery community meetings. Many dual diagnosis programs utilize the 12-step or a similar recovery philosophy into the rehab programming. The dual diagnosis program may incorporate A.A., N.A., “Double Trouble in recovery” (DTR), a 12-step designed specifically for individuals with a dual diagnosis, or an alternative program like SMART Recovery.

Addiction education and relapse prevention: Addiction specialists teach clients about how the brain reacts to substances and leads to addiction. Clients will participate in creating a detailed relapse prevention strategy by identifying the specific triggers or situations that could lead to a relapse, and listing actionable steps to prevent it.

Holistic therapies. Individuals with co-occurring disorders benefit from being introduced to holistic activities that can help them regulate stress and anxiety, and induce relaxation. These might include art therapy, yoga, mindfulness, therapeutic massage, deep-breathing techniques, and meditation.

Nutrition and exercise. Clients are coached on dietary choices and general nutrition to help them restore overall health and wellness in recovery. Daily exercise is encouraged during treatment and beyond, as regular physical activity helps naturally boost mood and regulate stress.

Aftercare services: Following completion of a dual diagnosis program, it is essential that aftercare services are included in continuing care strategies. Individuals recovering from a dual diagnosis face a challenging journey, so having access to recovery support services is key. Aftercare services include ongoing outpatient therapy, participation in a local recovery community, and possibly transitioning to sober living after rehab if the home environment is not supportive of recovery efforts.